Intensive care unit experience of haemopoietic stem cell transplant patients

Agarwal, Sidharth; O’Donoghue, Stephen; Gowardman, John; Kennedy, Glen; Bandeshe, Hiran; Boots, Robert

doi:10.1111/j.1445-5994.2011.02533.x

Cited by 31 publications

(30 citation statements)

References 21 publications

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“…In cohorts including only AlloSCT patients, hospital mortality and overall hospital mortality ranged from 77% to 98% and longterm survival ranged from 3% to 10% [22][23][24][25][26][27][28][29] . Similarly, Agarwal et al [30] reported higher ICU mortality rates between 1988-1998 compared to 1998-2008 in a single center. The improvement in ICU outcomes over the last few decades may have been due to improvements in intensive care, HSCT, and patient selection (Table 2).…”

Section: Discussionmentioning

confidence: 86%

“…Elevated serum lactate [16] , bilirubin [11] , and blood urea nitrogen [13,18] have been inconsistently found to be associated with worse prognosis. As for the organ function indexes, APACHE Ⅱ was not found to be predictive of ICU outcomes in HSCT population in various studies [10,13,30] except one [31] . In a cohort of 112 patients, Afessa et al [32] did not find APACHE Ⅱ to have prognostic value while they found APACHE Ⅲ to have a moderate discrimination and good calibration in predicting hospital mortality.…”

Section: Patient Functional Status At the Time Of Icu Admissionmentioning

confidence: 88%

“…Finally, Depuydt et al [33] reported that patients who were admitted to ICU with bacterial infection had a better prognosis than others, likely due to the more rapid improvement of bacterial infections with antibiotic treatment. In contrast, Agarwal et al [30] found fungal infections to be associated with higher mortality.…”

Section: Patient Functional Status At the Time Of Icu Admissionmentioning

confidence: 90%

“…Whether they affect the ICU outcomes is not as clear. Of the few studies that included both allogeneic and autologous HSCT [30][31][32] , only one demonstrated significantly worse prognosis after AutoSCT compared to AlloSCT [32] . However, these included small cohorts, and in the only recent study including exclusively AutoSCT patients [15] , ICU mortality was numerically lower than that in most AlloSCT patient cohorts.…”

Section: Transplant Related Factorsmentioning

confidence: 99%

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Intensive care outcomes in adult hematopoietic stem cell transplantation patients

Bayraktar

Nates

2016

WJCO

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Although outcomes of intensive care for patients undergoing hematopoietic stem cell transplantation (HSCT) have improved in the last two decades, the short-term mortality still remains above 50% among allogeneic HSCT patients. Better selection of HSCT patients for intensive care, and consequently reduction of nonbeneficial care, may reduce financial costs and alleviate patient suffering. We reviewed the studies on intensive care outcomes of patients undergoing HSCT published since 2000. The risk factors for intensive care unit (ICU) admission identified in this report were primarily patient and transplant related: HSCT type (autologous vs allogeneic), conditioning intensity, HLA mismatch, and graft-versus-host disease (GVHD). At the same time, most of the factors associated with ICU outcomes reported were related to the patients' functional status upon development of critical illness and interventions in ICU. Among the many possible interventions, the initiation of mechanical ventilation was the most consistently reported factor affecting ICU survival. As a consequence, our current ability to assess the benefit or futility of intensive care is limited. Until better ICU or hospital mortality prediction models are available, based on the available evidence, we recommend practitioners to base their ICU admission decisions on: Patient pretransplant comorbidities, underlying disease status, GVHD diagnosis/grade, and patients' functional status at the time of critical illness.

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Section: Discussionmentioning

confidence: 86%

Section: Patient Functional Status At the Time Of Icu Admissionmentioning

confidence: 88%

Section: Patient Functional Status At the Time Of Icu Admissionmentioning

confidence: 90%

Section: Transplant Related Factorsmentioning

confidence: 99%

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Intensive care outcomes in adult hematopoietic stem cell transplantation patients

Bayraktar

Nates

2016

WJCO

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“…It is possible that results of single centre studies can be attributed only to the site where the research was conducted due to individual characteristics of that centre not present in other settings. Many studies had long periods of data collection; eleven studies collected data for 10 years or more [31, 37, 42, 45, 48, 50, 51, 53–55, 57]. Collecting data over long periods can lead to era bias, where changes in hospital practice and policy, or improved treatments and technologies can affect patient outcomes.…”

Section: Resultsmentioning

confidence: 99%

A systematic review of prognostic factors at the end of life for people with a hematological malignancy

et al. 2017

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BackgroundAccurate prognosticating is needed when patients are nearing the end of life to ensure appropriate treatment decisions, and facilitate palliative care provision and transitioning to terminal care. People with a hematological malignancy characteristically experience a fluctuating illness trajectory leading to difficulties with prognosticating. The aim of this review was to identify current knowledge regarding ‘bedside’ prognostic factors in the final 3 months of life for people with a hematological malignancy associated with increased risk of mortality.MethodsA systematic review of the literature was performed across: PubMed; CINAHL; PsycINFO; and Cochrane with set inclusion criteria: 1) prognostic cohort studies; 2) published 2004–2014; 3) sample ≥ 18 years; 4) >50% sample had a hematological malignancy; 5) reported ‘bedside’ prognostic factors; 6) median survival of <3 months; and 7) English language. Quality appraisal was performed using the Quality In Prognostic Studies (QUIPS) tool. Results are reported in line with PRISMA guidelines.ResultsThe search returned 4860 studies of which 28 met inclusion criteria. Twenty-four studies were rated moderate quality, three were high quality and one study was deemed to be of low quality. Most studies were set in the ICU (n = 24/28) and were retrospective (n = 25/28). Forty ‘bedside’ prognostic factors were identified as associated with increased risk of mortality encompassing the following broad categories: 1) demographics; 2) physiological complications or conditions; 3) disease characteristics; 4) laboratory blood values; and 5) interventions.ConclusionsThe literature on prognosticating in the final months of life was predominantly focused on people who had experienced acute physiological deterioration and were being treated aggressively in the in-patient setting. A significant gap in the literature exists for people who are treated less aggressively or are on a palliative trajectory. Findings did not report on, or confirm the significance of, many of the key prognostic factors associated with increased risk of mortality at the end of life in the solid tumour population, demonstrating key differences in the two populations.Trial registrationThis systematic review was not registered.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-017-3207-7) contains supplementary material, which is available to authorized users.

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Haematopoietic Stem Cell Transplantation (HSCT)

Snowden

Webber

2014

Haematology in Critical Care

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Intensive care unit experience of haemopoietic stem cell transplant patients

Abstract: Our study found that acute admission of HSCT patients to the ICU is associated with improved survival compared to our previous experience, with organ failure progression a strong predictor of ICU outcome, and specific disease characteristics contributing to long-term survival.

Cited by 31 publications

References 21 publications

Intensive care outcomes in adult hematopoietic stem cell transplantation patients

Intensive care outcomes in adult hematopoietic stem cell transplantation patients

A systematic review of prognostic factors at the end of life for people with a hematological malignancy

Haematopoietic Stem Cell Transplantation (HSCT)

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